All replies must be constructive and use literature where possible.

• Ferlanda Pierrelus. 

Traumatic Loss and Coping

• The patient has suffered a traumatic loss. It is vital to get information regarding the patient’s social life and behavioral characteristics. The data is critical in determining whether she leads a socially active life or not. Additional subjective data to obtain from the patient would include the date of onset of the symptoms. If she reports that it occurred before the loss, it may be unrelated to the loss.

In addition, it might be prudent to inquire about the patient’s fatigue. A differential diagnosis would be determined by the patient’s impression and explanation of fatigue. Fatigue is described as an unexplained feeling of exhaustion that is not caused by exercise or other activity (Dunphy, Winland-Brown, Porter, & Thomas, 2019). The details of her behavior are crucial in determining the strength of her support system. Additionally, it is critical to determine whether the woman’s lifestyle is sedentary.

Assessment of the patient’s level of consciousness, mood, affect, and behavior would be additional objective results. The patient may appear exhausted, self-conscious, bored, inattentive, and lack interest in her environment. Furthermore, the patient’s general look should be evaluated. Finally, ascertain the amount and duration of the patient’s weight loss.

A malignant tumor may also be a differential diagnosis. Cancer’s widespread influence might cause comparable symptoms such as weight loss and cachexia. As the body’s needs increase, the patient may feel exhausted due to muscular weakening and tissue disintegration. Additionally, anemia can aggravate the symptoms (Hubert & VanMeter, 2018). Also, dementia, Alzheimer’s disease, anemia, chronic fatigue, and depression may be differential diagnoses.

Iron-deficiency anemia can be ruled out with laboratory tests. A complete blood count (CBC) may reveal abnormally low amounts of red blood cells, hemoglobin, hematocrit, or mean corpuscular volume (MCV), indicating anemia. For depression, screening methods such as the Patient Health Questionnaire (PHQ)-2 and PHQ-9 are widely used and validated (Dunphy et al., 2019). Additionally, cognitive evaluation instruments that can be used to diagnose specific neurological illnesses, such as the Mini-Cog or Mini-Mental State Examination, may be used.

The treatment plan would entail identifying whether there is an underlying cause other than grief. A complete blood count (CBC) and depression screening would be recommended. I would schedule a two-week follow-up with the patient to provide her time to complete the necessary tests and consultations. Patient education entails normalizing the patient’s emotions. Numerous individuals have similar mourning reactions. Yet, mourning is highly personalized, and there is no one-size-fits-all grieving method.

Additionally, it is critical for the patient to receive nutritional counseling. While her BMI is normal, if she does not eat, she may develop fluid and electrolyte imbalances, resulting in undesired complications. Encourage patients to take water or nutritional supplements such as Ensure. The provider’s role will encourage the woman to participate in activities she enjoys.

Although grieving is a natural part of life, her sister’s death was an unexpected and challenging event to deal with. The patient may be going through a difficult time emotionally. My recommendation would be to refer the patient to a psychiatrist or psychologist who could assist her in getting through this difficult time.

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing – an interprofessional approach (5th ed.).

Hubert, R. J., & VanMeter, K. (2018). Gould’s pathophysiology for the health professions (6th ed.).